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K Haag

Publications and source records attributed to K Haag.

At least 37 records · Page 2Linked to original sources
PubMed1995

Budd-Chiari syndrome: technical, hemodynamic, and clinical results of treatment with transjugular intrahepatic portosystemic shunt.

PURPOSE: To evaluate use of the transjugular intrahepatic portosystemic shunt (TIPS) as a nonsurgical approach for the management of Budd-Chiari syndrome (BCS). MATERIALS AND METHODS: Twelve patients with fulminant (n = 2), subacute (n = 5), or chronic (n = 5) BCS underwent TIPS placement. Hepatic venous obstruction was demonstrated at computed tomography and color duplex sonography. BCS was confirmed histologically in all patients. Hemodynamic parameters and clinical characteristics were assessed. RESULTS: TIPS creation was successful in all patients. Treatment reduced the portal venous pressure gradient by 75% and resulted in a mean shunt flow of 2,300 mL/min +/- 650 (standard deviation). No serious procedure-related complications were observed. The two patients with fulminant BCS died of septicemia or progressive liver failure despite intervention. The other 10 patients showed clinical improvement with reduction or disappearance of ascites. During follow-up, shunt dysfunction occurred in five of 10 patients with recurrence of ascites requiring repeat intervention. CONCLUSION: TIPS placement is safe and effective in patients with portal hypertension caused by subacute or chronic BCS.

Acute Disease↗
PubMed1995

Arterio-biliary fistula after transjugular intrahepatic portosystemic shunt: a life-threatening complication of the new technique for therapy of portal hypertension.

We report on a 70-year old woman with chronic active hepatitis and portal gastropathy who was treated with TIPS. On day 28 after TIPS implantation hemobilia occurred and radiological examination of the abdomen showed migration and kinking of the portal stent. During an emergency intervention the dislocated stent was splinted with a further stent. The suspected portobiliary fistula, however, could not be detected. The subsequent angiography of the hepatic artery showed an arteriobiliary fistula in the area of the dislocated stent. By means of microparticles and coils this fistula could be occluded angiographically; the bleeding stopped completely. Three days after the successful occlusion of the arterio-biliary fistula the patient died of disseminated intravascular coagulation. We therefore recommend in case of hemobilia after TIPS placement an immediate evaluation of the bleeding to exclude an arterio-biliary communication. In order to avoid stent dislocation it is advisable not to use combination of stents with a different design (e.g., Wall-stent and Palmaz-stent).

Aged↗
PubMed1995

Hepatic portal venous gas. Imaging modalities and clinical significance.

In a prospective investigation the sensitivity of conventional radiography, sonography, color Doppler flow imaging (CDFI) and CT in the detection of hepatic portal venous gas (HPVG) was compared in 7 patients with different diagnoses. For the identification of HPVG sonography, CDFI and CT have a higher sensitivity than conventional radiography. CT, however, was the most suitable method to identify the underlying cause of HPVG. Patients with iatrogenic HPVG as a result of diagnostic or therapeutic intervention had a good prognosis. In contrast, in all cases with a sudden appearance of HPVG and a noniatrogenic cause, exitus ensued within 1 week.

Abdomen↗
PubMed1994

The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding.

BACKGROUND: Transjugular placement of an intrahepatic stent is a new technique to establish a portosystemic shunt for treatment of portal hypertension. A puncture needle is advanced in a catheter through the inferior vena cava into a hepatic vein; then an intrahepatic branch of the portal vein is punctured and an expandable stent of metallic mesh is implanted to establish the shunt. METHODS: We attempted the stent-shunt procedure in 100 of 112 consecutive patients with variceal bleeding due to cirrhosis, who were then followed for a mean (+/- SD) of 12 +/- 6 months. Of the 100 patients, 22 had Child-Pugh class C cirrhosis, 10 were treated on an emergency basis, and 68 had alcoholic cirrhosis. The shunt was established with use of Palmaz stents expanded to 8 to 12 mm in diameter. RESULTS: Technical success was achieved in 93 percent of the patients. The mean (+/- SD) time for the procedure was 1.2 +/- 0.3 hours. The shunt reduced the portal venous pressure gradient by 57 percent. Major complications were hemorrhage (intraabdominal bleeding in six patients, biliary bleeding in four, and bleeding in the liver capsule in three) and migration of the stent into the pulmonary artery (in two patients). At follow-up, stenosis of the shunt was evident in 21 patients and occlusion in 10 patients; 10 of these 31 patients had variceal rebleeding. Stenoses and occlusions of the shunt were all treated successfully by redilation, thrombolysis, or implantation of an additional stent. Hepatic encephalopathy (stages I to III) developed in 25 percent of the patients. The proportion of patients with shunts who remained free of variceal rebleeding was 92 percent at six months and 82 percent at one year. The 30-day mortality was 3 percent. The cumulative one-year survival was 85 percent. CONCLUSIONS: These results suggest that the transjugular placement of an intrahepatic portosystemic stent is an effective and safe treatment for variceal hemorrhage in patients with portal hypertension due to cirrhosis.

Esophageal and Gastric Varices↗
PubMed1994

[Hemodynamics, liver function and clinical follow-up after TIPS].

In 126 patients with liver cirrhosis treated electively with transjugular intrahepatic portosystemic stent shunt (TIPS) to prevent variceal rebleeding, the portosystemic pressure gradient decreased by 60%. In spite of this incomplete effect the risk for variceal rebleeding was still under 20% after 2 years. Only 1 patient died of variceal rebleeding. Shunt insufficiency occurred in 50%, mainly during the first year, but shunt function was restored in nearly all cases by radiologic intervention, i.e., redilatation or implantation of an additional stent. During the follow-up of 16 +/- 9 months, 21 patients (17%) died, one-third of them from progressive liver failure aggravated in 4 cases by severe drinking. De novo hepatic encephalopathy was observed in 10%, especially in older patients and patients with impaired liver function before TIPS. In such patients it is recommended that the shunt be dilated to 0.8 cm at most, and the TIPS procedure can be combined with transjugular embolization of the varices. The advantages of TIPS over both endoscopic sclerotherapy and drug treatment must be clarified in randomized studies, which have already been initiated in several centers.

Catheterization↗
PubMed1994

[Duplex ultrasound studies after organ saving intervention in traumatic splenic rupture].

The increased risk of overwhelming postsplenectomy sepsis (OPSI) led to the development of organ preserving procedures. However, little is known about the long-term results of organ preserving. A reduced blood flow has been suspected. In the period from 1982 till 1990 144 patients were operated on for a ruptured spleen. Thirty patients had organ preserving procedures. These failed to stop the bleeding in eight patients. Two patients died. Nineteen patients (group A) out of twenty were reexamined clinically, by ultrasound and by Duplex sonography. They were compared with matched test persons. Three patients in group A complained of recurrent minor infections. Changes in the shape and the location of the spleen were a common sonographic finding. The diameter of the hilus was 3.8 +/- 0.5 cm and the blood flow was 221 +/- 75 ml/min in group A. There was no difference to group B with 3.8 +/- 0.6 cm and 224 +/- 76 ml/min, respectively. The hemodynamic preconditions necessary for a functioning spleen could be preserved in all patients.

Adolescent↗
PubMed1993

[Trans-jugular intrahepatic portosystemic stent-shunt (TIPS) in a patient with Budd-Chiari syndrome].

The surgical modalities for the management of Budd-Chiari syndrome are associated with high morbidity and mortality. The clinical course of a patient with subacute Budd-Chiari syndrome and a myeloproliferative disorder is described in whom, to reduce the portal hypertension, a transjugular intrahepatic portosystemic stent-shunt (TIPS) was implanted. TIPS is a new, still experimental procedure for the treatment of patients with portal hypertension which is used mainly for patients with recurrent variceal bleeding. An intrahepatic metal wire stent connects a main branch of the portal vein with a large hepatic vein and reduces the portal venous pressure as a side-to-side portosystemic shunt. In the patient described here the implantation of a TIPS was followed by rapid reduction of ascites production and a continuing general improvement.

Adult↗
PubMed1993

Transjugular intrahepatic portosystemic stent-shunt (TIPS) in the treatment of Budd-Chiari syndrome.

Budd-Chiari syndrome is characterized by splanchnic congestion due to obstruction of the hepatic venous outflow. A variety of treatment modalities have limited applicability due to their invasive nature, complications or low effectivity. The transjugular intrahepatic portosystemic stent-shunt (TIPS) offers a new treatment by creating an intraparenchymal duct between a main branch of the portal vein and hepatic vein i.e. the intrahepatic part of the inferior vena cava. This paper describes the treatment of two patients with fulminant and subacute Budd-Chiari syndrome treated 2 days and 2 months after the onset of clinical symptoms. It demonstrates that TIPS is a feasible treatment of Budd-Chiari syndrome that restores splanchnic blood flow, reduces collateral circulation and ascites and provides sufficient time to allow for elective liver transplantation, if indicated. Further studies are required to evaluate the effect of TIPS on liver function and survival.

Adult↗
PubMed1993

Angiotensin-converting enzyme (ACE)-inhibition in cirrhosis. Pharmacokinetics and dynamics of the ACE-inhibitor cilazapril (Ro 31-2848).

The angiotensin-converting enzyme (ACE)-inhibitor, cilazapril, is converted to its active metabolite, cilazaprilat, by ester hydrolysis in the liver. The pharmacokinetics and pharmacodynamics of a single 1 mg oral dose of cilazapril were investigated in 10 healthy volunteers and in 9 cirrhotic patients with compensated cirrhosis and portal hypertension. A significantly increased mean plasma peak concentration (40.0 +/- 13.6 ng/ml vs. 25.5 +/- 7.9 ng/ml; p < 0.05) and a decreased apparent oral clearance (7.8 +/- 6.0 l/h vs. 16.4 +/- 5.4 l/h; p < 0.05) of cilazapril were found in cirrhotic patients compared to healthy volunteers. The plasma concentration of cilazaprilat declined in 2 phases. In both phases the plasma half-life was significantly longer in patients with cirrhosis (1st phase: 2.5 +/- 0.8 h vs. 1.7 +/- 0.6 h; p < 0.05; 2nd phase: 46.2 +/- 16.6 h vs. 28.8 +/- 4.7 h; p < 0.001). Consequently, cilazaprilat concentrations at 24 h were higher in patients than in volunteers (1.42 +/- 0.33 ng/ml vs. 0.87 +/- 0.14 ng/ml; p < 0.001). The predose activity of the ACE (26.3 +/- 7.3 U/l vs. 16.8 +/- 4.5 U/l; p < 0.005) and plasma renin activity (3.3 +/- 3.2 ng/ml/h vs. 1.4 +/- 1.0 ng/ml/h) were higher in patients than in volunteers. Maximum ACE-inhibition occurred at similar times in patients (2.7 h) and volunteers (2.3 h). Maximum ACE-inhibition was slightly higher in volunteers (94.6%) than in patients (90.6%). At later time points (> 24 h), however, ACE-inhibition was more pronounced in patients (at 72 h: 39.6 +/- 6.9% vs. 23.5 +/- 8.2%; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Interventional treatment of portal hypertension.

For many years now, percutaneous transhepatic and transjugular approaches to the portal vein have been applied by gastroenterologists and radiologists for diagnosis and therapy. In patients with variceal bleeding these techniques were used to obliterate the varices, and have provided the knowledge for further developments, such as the creation of an intrahepatic portosystemic shunt by balloon dilatation of the needle tract between the portal vein and a hepatic vein. The recent development of expandable vascular stents has led to improvements in the efficiency and long-term patency of interventional shunts, and justified their clinical application. The rationales for this new approach to the treatment of portal hypertension are its relative safety, even in Child C patients, and the disabilities such as rebleeding or aggravation of hepatic encephalopathy of other current treatments. Since the first clinical application of the transjugular intrahepatic portosystemic stent-shunt in January 1988, the technique has been improved considerably, and the frequency of its application is increasing rapidly. This article attempts to summarize the current state of knowledge of this interventional technique, which will soon have its place among the various methods of treating portal hypertension.

Contraindications↗
PubMed1992

[Splenic size and duplex sonography determination of blood flow in the vena lienalis and vena portae in liver cirrhosis].

Splenomegaly is a common finding in patients with portal hypertension. In the present study the relation between spleen size and blood flow in the splenic and portal vein was evaluated in 33 patients with alcoholic liver cirrhosis and portal hypertension using pulsed Doppler sonography (Ultramark 9, ATL, Solingen, FRG). There was a significant positive correlation between hilar spleen diameter (HD) and splenic vein diameter (r = .73, p less than .001) as expected as the consequence of portal hypertension. However, a positive correlation between HD and splenic vein flow (SBF) was found (r = .67, p less than .001). Furthermore, there was no negative correlation between HD and flow velocity in the splenic vein (r = .01, n.s.). Portal blood flow (830 +/- 360 ml/min) was fairly constant in spite of considerable variations in SBF (range: 120 to 1200 ml/min). The data of the present study indicate that splenomegaly in patients with liver cirrhosis and portal hypertension is not simply the consequence of portal congestion resulting in decreased SBF. Rather, increased SBF serves to maintain portal blood flow and thereby contributes to portal hypertension. In few patients (15%) SBF increased to more than 11/min may be an important factor for the severity of portal hypertension. Surgical shunt treatment should be adjusted in these patients.

Blood Flow Velocity↗
PubMed1991

[Prerequisites for therapy of inflammatory bowel diseases. Pathophysiology--symptomatology--diagnosis].

The etiology of the idiopathic chronic inflammatory bowel diseases Crohn's disease and ulcerative colitis remains unclear. Differences in prognosis, medical and surgical treatment, and the nature of expected complications require not only a differential diagnosis vis-a-vis other disorders, but also the correct diagnosis of these two diseases. Symptomatology and clinical presentation can be mimicked both by infectious, ischemic and other chronic bowel diseases such as collagenous colitis, eosinophilic colitis, and Behçet's disease. This means that, in the absence of pathognomonic changes, the correct diagnosis can be established only on the basis of all the findings (laboratory, endoscopy, X-rays), and sometimes only on the basis of the course of the condition. The most important differential diagnostic procedure has proved to be ileocolonoscopy, since in addition to gross evaluation of the mucosa, targeted removal of biopsy specimens is also possible.

Colitis, Ulcerative↗
PubMed1991

Pancreatic lesions in the von Hippel-Lindau syndrome.

Common manifestations of the von Hippel-Lindau syndrome, an autosomally dominant inherited cancer-prone disorder, include retinal angiomatosis, hemangioblastoma of the central nervous system, renal cysts, renal cancer, pheochromocytoma, and epididymal cystadenoma. Multiple cysts and microcystic (serous) cystadenomas of the pancreas have also been reported occasionally in patients afflicted with this syndrome. In the large Freiburg study of the von Hippel-Lindau syndrome composed of 66 affected individuals, pancreatic lesions were systematically studied. Fifty-five living individuals were examined by abdominal ultrasound imaging. Abnormal findings were confirmed by computed tomographic scan and/or magnetic resonance imaging. For an additional 11 decreased patients autopsy data were available. Cystic lesions of the pancreas were found in 10 patients (15%). One of these patients presented with multiple pancreatic cysts as the only manifestation of the syndrome. In one patient, a malignant islet-cell tumor was found at autopsy. Because multiple pancreatic cysts did not cause major clinical symptoms and because follow-up examinations over an average period of 5 years did not show significant progression of the lesions, it is concluded that these patients usually do not require surgical treatment. Abdominal ultrasound screening is recommended for patients at risk as a tool to identify potential von Hippel-Lindau syndrome gene carriers with pancreatic manifestations. In all patients with multiple pancreatic cysts, the von Hippel-Lindau syndrome should be included in the differential diagnosis.

Adolescent↗